Factors influencing plasma donation behavior of COVID‐19 recovered patients in Bangladesh: A pilot study

Abstract Background and Aim The COVID‐19 pandemic has plagued our lives for more than 2 years, and the preference for convalescent plasma (CP) as a life‐saving treatment since CP has proven as a potential therapeutic option for acute COVID‐19 patients who were suffering from severe disease. It is important to identify which factors are associated with plasma donation. Therefore, this study aimed to assess the associated factors for CP donation to COVID‐19 patients. Methods A cross‐sectional study was conducted online from December 21, 2021 to February 15, 2022 to identify different socio‐demographic factors and knowledge related to CP donation. People who recovered from the COVID‐19 infections and those who are willing to participate were included in the study. A total of 60 participants were included in the study. The data were analyzed using descriptive statistics, correlation matrix, and factor analysis. Results The analysis results confirm that 41.67% (n = 25) of the participants aged 26–30 years; among the recovered patients, only about 23% (n = 14) of the participants donated plasma. Though 97% (n = 58) of the participants agreed to donate plasma when it will be needed, however, when someone asked to donate plasma then 76.67% (n = 46) of the patients declined it. Findings depict that gender had a weak positive relationship with ever decline in plasma donation at 5% level of significance and the age of the participants inversely related to plasma donation. Conclusion Almost all the recovered participants were willing to donate plasma, however, due to a lack of knowledge and misconception, relatively few people actually did. This study reemphasizes the importance of health education to overcome the misconception about plasma donation, which is crucial for the treatment of COVID‐19 infection.


| INTRODUCTION
The SARS-CoV-2 that is, COVID-19, began to alarm the world in the first days of 2020 amid its initial flare-up in China because of its severity. 1 COVID-19 was considered a new public health pandemic threatening the entire world with its rapid spread and causing deaths. On March 11, 2020, the World Health Organization (WHO) proclaimed that it was a worldwide pandemic due to the severity of the situation. 2 The COVID-19 pandemic impacted not only the health and well-being but also other sectors of the country. [3][4][5][6][7][8][9][10] Comprehensive immunization is mandatory to avoid the widespread transmission of SARS-CoV-2 as well as they only can help prevent the poor outcome of the disease. We are fortunate enough that the vaccine was developed, however, at an early stage, different alternative ways were used to stop it's spreading and combat it. A previous study highlighted that different types of actions were taken to reduce cases and fatalities all over the world. 11 A previous study in China revealed critical upgrades in patients influenced by the Coronavirus and treated with convalescent plasma (CP). 12 In the earlier period of the spread of these COVID-19 viruses, numerous endeavors have been made to treat wiped-out patients utilizing off-label drugs.
A year after the start of the COVID-19 pandemic, invented vaccination met people's high expectations and created immunizations that shield from SARS-CoV-2, the infection that causes COVID-19. However, vaccination is one of the most successful approaches to ward against and manage infectious diseases. Now it becomes a big challenge to make these vaccines available to cover all the people worldwide. 13,14 One of the world's first promising treatments for COVID-19 patients is the use of CP because it may help to recover the patients who were admitted to hospitals. 15 The CP could be used as a supplement to antiviral treatment. 16 So CP may be deployed within weeks of the commencement of future epidemics or pandemics caused by infectious diseases. 16,17 Moreover, Dr. Jed Gorlin, adjunct professor in the Department of Laboratory Medicine and Pathology at Hennepin Healthcare and Children's Hospitals and Clinics of Minnesota, said that "The risk of giving one unit of plasma is minimal, and as far as specifics, we're learning after the fact." 18 CP therapy was widely practiced by clinicians in Bangladesh during the first and second waves of the pandemic, so we wanted the investigate the factors influencing the plasma donation behavior among the recovered patients at that time.
The government of Bangladesh has established the "Shohojoddha" plasma network to simplify the availability and accessibility of plasma from coronavirus patients. Under this effort, many public and private sector partners collaborated to develop the platform. 19

| METHODOLOGY
The study was conducted among COVID-19 recovery patients in Bangladesh between December 21, 2021 andFebruary 15, 2022 through an online survey. Before involvement in this survey, the authors informed the respondents about the objective of this study using phone calls, Facebook Messenger, and WhatsApp, and made sure that the information they provided would be reserved privately and no identifiable information will not be disclosed along with oral consent was taken. Participants who were willing to participate and contribute to this study were then sent a link to the designed Google form along with instructions to complete it. The link to the designed Google form was shared with participants via email and various social media groups. The respondents finally agreed to provide authorization for their data to be used in the study. The whole study design is described by a flowchart presented in Figure 1.
There are several guiding principles for determining the right sample size for pilot research so that different features of interest, such as effect size, the standard deviation of the outcome measure, reliability, or confidence level, may be determined with adequate precision. [21][22][23][24] However, Viechtbauer et al. 25 described a F I G U R E 1 Flowchart of the study straightforward method to estimate the required sample size for a pilot study, with a preferred level of confidence and a specified probability. 25 Researchers used the following formula for pilot study. 26 Bearing in mind, Considering a 95% confidence level γ ( = 0.95) with probability π ( = 0.05) , the essential sample size for this pilot survey has been determined by the following formula, Hence, this formula suggests that a sample of size 59 is sufficient for a pilot survey. A total of 60 participants were included in the final analysis after discarding the five incomplete responses. A few (5%) of respondents prioritized their families only but were not willing to donate plasma to others. Here, the author's accepted multiple responses (Figure 2). The scree plot of eigenvalues is used to select the number of factors based on the size of the eigenvalues, which is visualized in Figure 3. This scree plot shows that the first five factors account for most of the total variability in the data. The first five components have eigenvalues greater than 1. We may consider these strong factors. After that, eigenvalues of component 6 and onwards were dropdown slowly, that is, an elbow has been observed in component 5, that is, the excess factors represent an exceptionally small extent of the changeability and are likely insignificant.
After Varimax rotation had been performed on the data, from the following rotated factor matrix, we could assert that Factor 1 has high positive factor loadings for occupation (0.820), age (0.818), educational status, who living with and high negative loadings for marital status (-0.794), so this factor describes the patient's demographic characteristics. Factor 2 differentiates reasons for declining to donate plasma and ever declining to donate plasma with high factor loadings, so this factor may be labeled as the reasons behind declining. Factor 3 has high positive factor loadings for preference for plasma donation and will donate plasma if needed, so this factor might be depicted as the perspective of plasma donation. Factor 4 included variables like a token that should be given to donors, blood groups, and place of residence, called basic information. Lastly, factor 5 has high factor loadings for donating plasma, gender, and wealth index, which may represent plasma donation (Table 3).

| DISCUSSION
The quick start-up of a COVID-19 CP program worked well 27 ; however, the COVID-19 pandemic had a negative impact on blood donation. 28 This article provides an opportunity to explore the F I G U R E 3 Scree plot of eigenvalues after factor analysis Donating plasma during the COVID-19 pandemic was linked with perceived risk, severity, anxiety, and response cost. 32 Moreover, a lack of empathy is a key factor in discouraging blood donation. 28 The public's willingness could be increased by raising awareness and disseminating information about the importance of COVID-19 CP. Moreover, the government and policymakers should give importance to health education to all people to overcome the misconception about plasma donation.
CP therapy treatment has been utilized since the mid-1900s to treat irresistible infections, in the absence of antivirals and monoclonal antibodies, the CP can be treated as a life-saving treatment. 33 CP is being studied worldwide, as a treatment for COVID-19 and prevention, however, it did not reduce all-cause mortality. [34][35][36] Researchers recommend that CP treatment could be a viable alternative in the event of a COVID-19 emergency. 37 However, there is no evidence of benefit shown by several trials with COVID-19 patients, therefore, it is rarely practiced nowadays.

| STRENGTH AND LIMITATIONS
The strength of this study is that it is the first study in Bangladesh however, it has some limitations. Firstly, since it is a pilot study, the sample size is very small, which may not represent the overall country's situation. Secondly, face-to-face data collection was not possible considering the pandemic situation as a result the study may have some sample selection bias.

ACKNOWLEDGMENT
The authors are grateful to the respondents for participating in this study and providing consent to publish the study findings by deleting identifiable information. The authors would like to express their gratitude to the four anonymous reviewers and the Editor for their insightful comments and suggestions, which helped to improve the manuscript's quality. This research received no specific grant from any funding agency in public, commercial or not-for-profit sectors.

CONFLICT OF INTEREST
The authors declare no conflict of interest. Furthermore, none of the authors participating in this research communication has any connections with other people or organizations that could impact (bias) the findings in an unethical way.

TRANSPARENCY STATEMENT
The lead author Md. Moyazzem Hossain affirms that this manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

DATA AVAILABILITY STATEMENT
The authors confirm that the data supporting the findings of this study are available within the article, and data will be available upon a reasonable request to the corresponding author.